How Common Is Back Pain?
Back pain has reached epidemic proportions in the Western world. Our sedentary lifestyle coupled with our allopathic approach of merely treating symptoms has led this injury to reach a point where 9 out of 10 adults now experience back pain at some point in their life!
Only colds and flu beat low back problems for Doctor visits! It is not limited to people who don’t exercise and can cut down even the fittest people. When a serious episode hits it can send some people into panic mode which is where treatments like pain medications and getting a therapist to “fix you” are born.
Surgery would be the next step if solutions are not found.
But really that should be a last resort, and to be honest even then it may make matters worse! There is a better way, that is less expensive, less invasive and to be honest much more successful. But you have to have an intelligent way of going about treating this injury at the source to have an effective long term solution. There is a lot more to this injury than just taking a pill, getting a massage and doing a few random stretches. Getting rid of pain and getting rid of the injury are two completely different things.
To paint a picture of how bad back pain really is here are some stats:
In 2009 1 in 7 Australians (13.6%) reported having serious back problems—that’s 3 million people!
Over 2 in 5 people with back problems (44%) have difficulty in tasks and activities associated with mobility, communication or self-care
1st according to the Global Burden of Disease estimates, low back pain is ranked 1st in Australasia (including Australia and New Zealand), compared to 6th in the world
How do back problems affect quality of life?
Compared to those without the condition, people with back problems are:
2.4 times as likely to report poor health
2.6 times as likely to report very high levels of psychological distress
2.5 times as likely to report severe and very severe pain
3.4 times as likely to report a core activity limitation (for example, self-care or mobility).
How much is spent on back problems? Based on AIHW disease expenditure data, $1.2 billion was at-tributed to back problems in 2008–09 (the most recent year for which data are available).
The message is clear this is a massive problem.
Find The Cause & Stop Treating Symptoms
Our approach to treating pain is that it is a real inconvenience and that there must be some kind of pill, tablet or medical intervention to just get rid of it. We are taught that we just need to remove the pain, not address why we have the pain! And with back pain this is a disaster for the injury gets worse the longer the source of the problem remains.
Now I mentioned Surgery should always be a last resort. After every other option has been exhausted. Yet often you find today, this is almost the first option. With back pain it really is very ineffective. Apart from the fact it does not address the cause the success rate with surgery is usually very poor. There has recently been countless books and articles written by well respected surgeons questioning the benefit of many of the most common surgeries being performed. Dr David Hanscom an orthopedic surgeon in Seattle advises his patients to avoid spinal surgery. He says it best below.
“The success rate of the spinal fusion for back pain was about 24 percent, but we still kept doing it. Then, in 1994, when this paper came out Washington showing that the return-to-work rate one year after a spinal fusion for back pain was 15 percent, I just stopped. Every paper since then has showed pretty much the same dismal results; there’s maybe a 20 to 25 percent success rate of spinal fusion for back pain… And the downside of a failed spine surgery is terrible. It’s really bad. These people are condemned to live their entire lifetime, 30 to 40 more years, in chronic pain.” Despite such findings, spinal fusions are still popular. Each year, some 600,000 spinal fusions are performed in the U.S. with a high percentage of them being performed for non-specific low-back pain, at a cost of more than $600 billion.”
And to quote leading back pain researcher Stuart McGill in his book Back Pain Mechanic.
“The fundamental law is this; an episodically pained patient is not a surgical case. The fact that they have pain free days shows they simply need to identify the triggers that cause a painful day and eliminate them.”
What Is The Root Cause Of Back Pain?
Well if I keep harping on about the fact we need to address the Root Cause of back pain, what is it? If your injury was not from a collision or accident and just appeared out of nowhere then it is one of two things:
- POSTURAL problem and was caused from repetitive activities such as lying on the couch, poor running technique, sitting for too long in an awkward position day after day etc.
- MOVEMENT pattern dysfunction that you have developed and been using not knowing there was anything faulty with how you move.
Previous injuries are also a common cause and need to be considered as these may have set off the chain reaction of movement or postural problems. For example an ankle injury that you continue to walk or even run that eventually causes you to limp, now places abnormal pressure into the “normal” side potentially creating a hip problem causing the spine to flex and move due to the stiffness in the hip. No pain is present straight away as it is a build up over time until one day…………. Bang!
Basically you created a new injury in your efforts to avoid pain.
Pain is the fastest way to change a movement and disrupt the timing and sequence of movement in the entire kinetic chain leading to pain or injury in the spine.
If we take a look at postural causes first for this gives us a good idea of where to start. Posture is very important to look at first for this is basically observing the structure of the skeleton in it’s resting place. There is no point trying to change how you move if you are not even lined up in the right place before you even started. Poor posture not only takes away from looking good, it compromises how we were designed to function, eventually leading to pain and/or injury.
The Most Common Things To Look For Are
- Amount of time spent sitting
- Your office chair and computer set up, your driving position and seating in your car
- Crossing your legs too often
- Standing unevenly
- Wallet in your back pocket (yes this is very common)
- Poor footwear creating excessive pronation
- Repetitive sports or occupational tasks. Eg Golf, packers etc
Now it is not as easy to stop sitting all the time if this is what your job requires. You could switch to a standing desk and I do know many people who now do this and would never go back to a chair. But if you do need to still sit, then there is 3 things you must do.
- Take regular breaks
- Use corrective exercises and stretches to prevent the muscle imbalance and postural faults from being formed.
- Make sure your workstation is set up correctly.
- Movement Dysfunction
This one is not so easy to define and you will not always be able to easily identify this yourself. There are many people who we find during a postural assessment they are well aligned and look “pretty good”. Yet they come to see us for pain. When we test them for flexibility imbalances we do not find too much that seems wrong. So why are they in pain? Their structure is well aligned it makes no sense. In this case it is how they are using their body to move that is the problem. The structure starts out okay but the way it is used forces problems and eventually pain.
With back pain there is so many different types, yet we find that most will fit into 2 distinct categories.
- Flexion Related Back Pain
Flexion related back pain is the person who has the C-curve type posture and has a real hard time trying to use their hips to do the work of bending and preferring instead to use their spine. This person is a candidate for bulging disc. They will often have very tight hamstrings, hips and thoracic spine. The abdominal muscles are also commonly tight which is why most core programs will exacerbate this problem instead of helping it! The correction for this movement problem is learning to hip hinge correctly using various methods of deadlifts.
Can you see how doing surgery on their discs is a complete waste of time if you do not address the fault in how they bend over?
Just think of how many times you would need to use the bending action in a day and how if the only way you know how to move is a faulty one, that it is inevitable you will end up in pain again!
- Extension Related Pain
This condition is as the name suggests the exact opposite problem. This person has developed excessvie curvature of the lumbar spine that is now causing compressive problems. Again we will see very tight hips and back extensors for this person, with glutes & abdominal muscles typically very weak. This tends to be more common in females, but not limited to. This person will often struggle with the lunge and any type of exercise that requires stability of the pelvis. As opposed to the flexion related person who has a pelvis being pulled under this person has a pelvis being tipped forward. If you do not address this dysfunction pain will continue no matter what you do for the spine is being continually compressed.
Okay we have covered a lot of ground in terms of understanding how we actually get back pain. If your problem is not from a serious accident out of your control your problem is something you have created from poor repetitive movements or lack of movement. It is not bad luck, it is not genetics, and it certainly is not a lack of surgery or due to old age. We must pay attention to the signals our body is providing and become better equipped on how to manage and control them. In part 2 we are going to look at the first 2 steps in addressing these dysfunctions using exercise.